Treatment of Acute Aortic Type B Dissection with Stent-Grafts

Abstract

Endoluminal treatment of acute type B aortic dissections seems to be an attractive alternative treatment to surgical repair. Thrombosis of the false lumen of the thoracic aorta can be induced if the primary tear is sealed with a stent-graft. This could protect the dissected thoracic aorta from delayed rupture.

Endoluminal treatment of aortic dissection

“…If the diameter of the chosen endograft is too large as compared with the diameter of the non-dissected proximal aortic segment, the endograft may be extruded out of this segment and dislocate distally during or after release. The mean length of the endografts used by Dake Results: stent grafts for proximal entry closure Stent-graft deployment is generally possible in all cases with successful entry closure in 86-100% of the patients [3,4,27,28,29,30,31]. Both Nienaber [4] and Hausegger [30] have treated dissections with entries 5 mm or more away from the origin of the left subclavian artery.…”

“…The mean length of the endografts used by Dake Results: stent grafts for proximal entry closure Stent-graft deployment is generally possible in all cases with successful entry closure in 86-100% of the patients [3,4,27,28,29,30,31]. Both Nienaber [4] and Hausegger [30] have treated dissections with entries 5 mm or more away from the origin of the left subclavian artery. To successfully occlude the entry site, the left subclavian origin had to be covered by the endograft fabric in 4 of the 5 patients treated by Hausegger et al [30].…”

“…Both Nienaber [4] and Hausegger [30] have treated dissections with entries 5 mm or more away from the origin of the left subclavian artery. To successfully occlude the entry site, the left subclavian origin had to be covered by the endograft fabric in 4 of the 5 patients treated by Hausegger et al [30]. Only one of these patients required a carotid-subclavian bypass.…”

“…Kato et al chose an endograft diameter which was 10-20% more than the diameter of the aortic arch where the endograft was to be anchored [2]. Hausegger et al chose an endograft diameter approximately 4 mm larger than the diameter of the nondiseased aortic segment [30]. If the diameter of the chosen endograft is too large as compared with the diameter of the non-dissected proximal aortic segment, the endograft may be extruded out of this segment and dislocate distally during or after release.…”

“…Accidental or even intentional coverage of the origin of the left subclavian artery with the stent-graft fabric is not always associated with arm ischaemia and is sometimes even electively performed by some of the authors. Should such ischaemia occur, a surgical carotidsubclavian bypass can be carried out as a second-stage procedure [28,30].…”